Advertisement

Development of an Algorithm for the Diagnosis of Otitis Media

Published:March 29, 2012DOI:https://doi.org/10.1016/j.acap.2012.01.007

      Abstract

      Background

      The relative importance of signs and symptoms in the diagnosis of otitis media has not been adequately evaluated. This has led to a large degree of variation in the criteria used to diagnose otitis media, which has resulted in inconsistencies in clinical care and discrepant research findings.

      Methods

      A group of experienced otoscopists examined children presenting for primary care. We investigated the signs and symptoms that these otoscopists used to distinguish acute otitis media (AOM), otitis media with effusion (OME), and no effusion. We used recursive partitioning to develop a diagnostic algorithm. To assess the algorithm, we validated it in an independent dataset.

      Results

      Bulging of the tympanic membrane (TM) was the main finding that otoscopists used to discriminate AOM from OME; information regarding the presence or absence of other signs and symptoms added little to the diagnostic process. Overall, 92% of children with AOM had a bulging TM compared with 0% of children with OME. Opacification and/or an air-fluid level was the main finding that the otoscopists used to discriminate OME from no effusion; 97% of children diagnosed with OME had an opaque TM compared with 5% of children diagnosed with no effusion. An algorithm that used bulging and opacification of the TM correctly classified 99% of ears in an independent dataset.

      Conclusions

      Bulging of the TM was the finding that best discriminated AOM from OME. The algorithm developed here may prove to be useful in clinical care, research, and education concerning otitis media.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media.
        Pediatrics. 2004; 113: 1451-1465
        • Hayden G.F.
        Acute suppurative otitis media in children. Diversity of clinical diagnostic criteria.
        Clin Pediatr (Phila). 1981; 20: 99-104
        • Shaikh N.
        • Harvey K.
        • Paradise J.L.
        • et al.
        The Cochrane Library and acute otitis media in children: an overview of reviews.
        Evidence-Based Child Health. 2009; 4: 390-399
        • Shaikh N.
        • Hoberman A.
        • Paradise J.L.
        • et al.
        Development and preliminary evaluation of a parent-reported outcome instrument for clinical trials in acute otitis media.
        Pediatr Infect Dis J. 2009; 28: 5-8
        • Kaleida P.H.
        • Stool S.E.
        Assessment of otoscopists’ accuracy regarding middle-ear effusion. Otoscopic validation.
        Am J Dis Child. 1992; 146: 433-435
        • Shaikh N.
        • Hoberman A.
        • Paradise J.L.
        • et al.
        Responsiveness and construct validity of a symptom scale for acute otitis media.
        Pediatr Infect Dis J. 2009; 28: 9-12
        • Breiman L.
        • Friedman J.H.
        • Olshen R.A.
        • et al.
        Classification and Regression Trees.
        Wadsworth, Inc., Monterey, Calif1984
        • Hoberman A.
        • Greenberg D.P.
        • Paradise J.L.
        • et al.
        Effectiveness of inactivated influenza vaccine in preventing acute otitis media in young children: a randomized controlled trial.
        JAMA. 2003; 290: 1608-1616
        • Shaikh N.
        • Hoberman A.
        • Kaleida P.H.
        • et al.
        Otoscopic signs of otitis media.
        Pediatr Infect Dis J. 2011; 30: 822-826
        • Hendley J.O.
        Clinical practice. Otitis media.
        N Engl J Med. 2002; 347: 1169-1174
        • Holt L.
        • McIntosh R.
        Holt’s Diseases of Infancy and Childhood.
        11th ed. D. Appleton-Century Co, New York1940 (385)
        • Paradise J.L.
        Otitis media in infants and children.
        Pediatrics. 1980; 65: 917-943
        • Paradise J.L.
        On classifying otitis media as suppurative or nonsuppurative, with a suggested clinical schema.
        J Pediatr. 1987; 111: 948-951
        • Hoberman A.
        • Paradise J.L.
        • Rockette H.E.
        • et al.
        Treatment of acute otitis media in children under 2 years of age.
        N Engl J Med. 2011; 364: 105-115
        • Tahtinen P.A.
        • Laine M.K.
        • Huovinen P.
        • et al.
        A placebo-controlled trial of antimicrobial treatment for acute otitis media.
        N Engl J Med. 2011; 364: 116-126
        • Laine M.K.
        • Tahtinen P.A.
        • Ruuskanen O.
        • et al.
        Symptoms or symptom-based scores cannot predict acute otitis media at otitis-prone age.
        Pediatrics. 2010; 125: e1154-e1161
        • Heikkinen T.
        • Ruuskanen O.
        Signs and symptoms predicting acute otitis media.[comment].
        Arch Pediatr Adolesc Med. 1995; 149: 26-29
        • Ingvarsson L.
        Acute otalgia in children—findings and diagnosis.
        Acta Paediatr Scand. 1982; 71: 705-710
        • Niemela M.
        • Uhari M.
        • Jounio-Ervasti K.
        • et al.
        Lack of specific symptomatology in children with acute otitis media.
        Pediatr Infect Dis. J. 1994; 13: 765-768